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Do you think you need legal help, have a question, or would you like to alert us about a potential abuse or neglect situation?  

If so, please fill out the form below. Tell us about the problem or question you have. Be as detailed as possible. This information helps us to understand your needs and if we may be able to help.  

Click ‘Send’ when you are done.  DLC’s Intake Team will contact you as quickly as possible.  


DLC’s Intake Team accepts new requests for help between 9 am and 1 pm on Mondays, Tuesdays, and Wednesdays. While we do our best, we may not be able to respond to requests for help outside of these hours.  

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Name of individual with the disability:
This Online Intake Form does not create an attorney-client relationship with DLC. DLC will review your Online Intake Form to consider what help we can offer.
Date of birth of the individual with the disability:
Address of the individual with the disability:
Problem Area:
Do you have any concerns about your representative payee?
If you are not the individual with the disability, state your name:
By checking this box, I agree to receive SMS content (text messages) from DLC

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